Evaluasi proses pengembangan dan implementasi standar pelayanan medis bedah sear dan apendisitis akut di RSUP DR. Sardjito

SITORUS, Sarmauli,

2006 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Tindakan bedah sesar dan apendektomi merupakan pelayanan yang high-risk clinical areas, dimana area ini sering diklaim untuk diminta pertanggung-jawaban profesional medis. Sejalan dengan peningkatan mutu, Komite Medik yang beranggotakan keseluruhan Staf Medik Fungsional (SMF), masing-masing membuat Standar Pelayanan Medis (SPM) terutama pada kasus-kasus pelayanan yang bervolume besar atau berpotensi menimbulkan risiko. Standar Pelayanan Medis membantu para profesional dalam mengambil keputusan diagnostik atau skrining, pemberian terapi atau tindakan bedah yang berbasis bukti terkini (evidence based medicine = EBM). Penelitian ini bertujuan untuk mengevaluasi kepatuhan dokter terhadap SPM dan faktor-faktor yang terkait dengan proses penyusunan dan implementasi SPM di rumah sakit pendidikan. Metode: Cross sectional survey dengan tehnik audit klinik dan wawancara untuk mengidentifikasi variasi implementasi SPM bedah sesar dan apendisitis akut, serta faktor-faktor yang terkait dalam proses penyusunan dan implementasi SPM. Semua pasien yang menjalani operasi bedah sesar dan apendektomi dari 1 Januari – 30 April 2005, Data diambil dari Rekam Medis RS Dr. Sardjito, Yogyakarta. Hasil: Untuk SPM bedah sesar didapatkan 100% kepatuhan terhadap indikasi bedah sesar, kepatuhan terhadap terapi AB profilaksis 3,5%, AB injeksi generik 42,4%, AB oral generik 60%, patuh terhadap lama pemberian AB injeksi sampai 24 jam post op 34,2%, patuh terhadap lama pemberian AB oral 84,7% dan patuh perawatan 85,8%. Untuk SPM apendisitis akut yang dilakukan apendektomi didapatkan kepatuhan terhadap indikasi appendektomi 75,5%, kepatuhan terhadap terapi AB profilaksis 59,2%, AB injeksi generik 42,8% dan AB oral generik 10,2%. Kepatuhan terhadap lama pemberian AB injeksi sampai 24 jam post op 51,1% dan patuh terhadap lama pemberian AB oral 46,9%. Patuh perawatan 77,5%. Gambaran isi SPM bedah sesar, belum berdasarkan EBM sedangkan gambaran isi SPM apendisitis akut masih sesuai dengan EBM. Faktor-faktor yang terkait dalam proses penyusunan SPM, yaitu adanya tim, sosialisasi, implementasi, monitoring dan evaluasi yang belum maksimal dilakukan. Variasi implementasi SPM sangat tergantung kepada kasus yang ditangani. Kesimpulan: Para dokter perlu mematuhi SPM yang sudah diberlakukan. Isi SPM hendaknya selalu mengikuti perkembangan ilmu terkini. Perlu adanya tim SPM yang memperbaharui, memantau, mengawasi, merevisi dan bekerja sesuai dengan jadwal yang sudah ditentukan.

Background: Appendectomy and Caesarean Sections are high-risk clinical service, which often claims the responsibility of medical professionals. Along with quality improvement, medical committee, which includes functional medical staff, write medical service standard to handle cases especially in cases of high volume services or risk potential services such as appendectomy and caesarean sections. This standard helps the professionals in making decision on diagnostic and screening, undertaking therapy or surgery with evidence based medicine. The purpose of this study was to evaluate physicians’ adherence toward medical service standard and factors related to the implementation of medical service standard at the teaching hospital. Method: This research applies cross sectional survey. Clinical Audit technique is also used to identify the variation of implemented medical service standard of appendectomy an caesarean sections. Patient underwent appendectomy and Caesarean Sections from January 1st to April 30 th, 2005. Data were taken from medical record of Dr. Sardjito Hospital, Yogyakarta. Results: Medical service standard of caesarean sections shows that all of the audited medical record cases (73) were indication compliance. There were 3,5% cases of antibiotic prophylaxis therapy, 42,4% cases of antibiotic generic injection therapy, 60% cases of antibiotic oral generic therapy, 34,2% cases of 24 hours post surgery of antibiotic injection therapy, and 84,7% cases of 5 days oral antibiotic usage. There were 85,8% cases of nursing care. Medical service standard of appendectomy shows that 75,5% of indication compliance, 59,2% cases of antibiotic prophylaxis therapy, 42,8% cases of antibiotic generic injection therapy, and only 10,2% cases of antibiotic oral generic therapy. There were 51,1% of 24 hours post surgery antibiotic injection therapy, 46,9% cases of 5 days oral antibiotic usage and 77,5% of nursing care. The caesarean section medical service standard is not based on evidence medicine yet but appendectomy medical service standard is based on evidence. Factors related to the creating process of medical service standard were teams, socialization, implementation, monitoring and evaluation but is not working maximum. The variation of medical service standard implementation depends on the case. Conclusion: Physicians have to obey implemented medical service standard. The content of medical service standard should follow the evidence base medicine. Team medical service standard is needed to renew, monitor, control, revise and work according to established schedule

Kata Kunci : Manajemen Rumah Sakit,Standar Layanan,Bedah Sesar, medical service standard, medical committee, caesarean section, appendectomy, teaching hospital